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HomeMy WebLinkAboutBuilding Permit # 9/23/2016 ooRTH 4F,�ztiffR r�p't'p BUILDING PERMIT ` TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 41 No#: " . Date Received ��s ATED permit _ ) y.° lete all items on tl�zs page Date Vssued scant must comp h Il�/It QRTA P �,r,� ,�i /���r/i,or✓ir//i///////l//,//i%//li/ ,�ii,i�/i/r j�//,, iii��;, /,�i��,;/ r t r ,, �yy,,�� /o / /rr� // ,/,,,, r � i. ,, ,ter r,/ ✓ , PROPOSED ENUSE ___ �j Residential TYPE OF IMPRT Ca One family � Industrial Neve Building u Two or more family o Addition Two of units: Commercial Alteration — o- _ ----, Cl Others: —--- Ll Assessory Bldg Ci Repair, replacement ci Other D Demolition I�astr�pr ' / FlooC '� r/ Zv/ // ,,, „r�„i © war /, ; PERFORM �,, DESCRIPTIC)�CFfORT E P a A o, 'LAI Iclentifiic �,�on - �'P Phone: OWNER: Name: Address - - / er r rte,„✓,:, / r r /` �, /ii / /i r/ r,..,,.: r ii ,,,/ %.,,,,,,.. a.. -.rn vr,r, ,.,,,,/i/%// r ;,, : GtICl�ilr / ,,,,, r / ✓�/„i /✓ / ro // / /i / /// %/ r �� r/ r '// /i �1 %///i y ,/ ri,, ,ur,, /, ,. ri/r,� 0 Phone: _ ARCHITECTIENGINEER Reg. No. Address: FEE SCHEDULE:gULpiNG PERMIT:$92.00 PER$'1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 00000000 06/ FEE: $ Total Project Cost: $ �, ) mmm — Receipt No.: Check No.: is ed contractors do net have access to the gua anty fend NOTE: Persons contracting,, nr i"nature of contactor AnP.n1/6wnerY _ 00RTH own of 6 ndover O 0 No. � � 4AK4 h ver, Mass,5 . CoCM[CN@wKR Q� `aaarEo a ,�5 S U BOARD OF HEALTH Food/Kitchen PE MIT Septic System R i�� I - T D THIS CERTIFIES THAT BUILDING INSPECTOR lift5%1eV"..:�has permission to erect .. ........................ buildings on ... Foundation ... ........................,.... Rough tobe occupied as ........... .... . ..... A .. ........................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building'Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN G MONTHS ELECTRICAL INSPECTOR LESS C . T . Rough Service . .! BUIL©ING.IN PEC. R. Final GAS INSPECTOR Occupancy Permit Required to Occupyffy Rough Display in a Conspicuous Place on the Premises -- Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. TOWN OF NORTH ANDOVER . ` ® OFFICE OF BULDING DEPARTMENT - 1600 Osgood Street,Building 20, Suite 2035 North Andover,Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings, Fax (979)688-9542 H-C) E°OWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION i Please prizzt Ck DATE: 2260 JOB LOCATION: QQ0 Number Street Address Map/Lot HOMEOWNERCs - Name Home Phone Work Phone o PRESENT mAILue ADDRESS 9 City Town State Zip Code p� g The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. u DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.(7 80 CMA Section 110.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with State Building Code and other applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands Wown of North Andover Building Department mmunum inspection procedures and req ' is and at e e 11 comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 658-9541 CONSERVATION 688-9530 HFALT14 6889540 PLANNING 685-9535 I The Commonwealth of.Massachusetts F Department of-[ndustrial Accidents rw . r T Congpess Street, Smite 100 Bostou,mA 02114-.2017 www.mass.gov/dia • +-«f 5yY yyorlrers, compensation TnsuranedAffidavit:Sufilders/ContXaciors/ElectricianslPltYwl�ers. f0 13E y)MED WITH THE I.ri WaTTlNG AUTAOPITy- Please Print Le 'bl A ' licant Tn£ormation ' Name (Business/Orgasiiza#iodntlividual): Address: C Sm4k Phone City/State/Zia: the appropriate box: Type ofprojeat(required); Aare you an employer?Cl}ecic , era Io ees frill'd/0'part tuna}. ]. N�- 'd61nstr6ction 1. I am a employer with p y 3 2.�I a�n a sole proprietor or partnersbip and Gave no employees v7nsking forme in $. Remodeling c owarkers'comp.insurance required.] 9, ❑DeITt011ii017 any capacity.[N •- I 3 I am a homeowner doing all workmys'If, NO workers'comp.insurance required.]' 10❑Building addition }•❑I am ahomeowner and will be hiring contractors to conduce all work onmy property. Twill 1 Electrical repairs or additions ensure that all contractors either have workers'Compensation insurance or aro sole 12YL�Plmbin g repairs or additiorti proprietors with no employees. [ J 5, I am a general contractor and I have hiredthe sub-contractors listed on the attached sheet. 1.3%n Roof repairs Thasesub_contractors Piave employees acid have workers'camp.insurance t 14. Other --- These e are a corporation and its.officers have exercised thein right of'exemption per MCrI c. 152,§1(4),and we'havena empldyees,[No Workers'comp.insurance required.] iy applicanttbat cheeks box41 must also fill out the sectionbelnW showingtheirworkers'compensation policy information. I Homeowners who submit flus aidavit indicatingthey are doing all work andthen lire outside contractors must submit anew affidavit indicating such -joraetContraotors that check this Bob must attached'an additional sheet showing the name of tlxe sub-contractors and statgwhatbez or oat those entities have °s employees. 7ftha sub contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providing-Worlters'compensation insurance for my employees. Below is floe policy orad j oti site information. Insurance Company Name: Expiration Date= policy#or Self-ins. City/State/zip: Sob Site Address: sltovvin the Clic nuzabex and expiration date). Attach a copy of the workers' c°mpeTtsatzon policy declaration page( g p Y 9 Failure to selation punishable by a Mb Up to$1,5 00-00 cure coverage as t,as- ell as iaiM penalties in he form.of criminal T P WoP RDER a d a EM of up to $250.00 a and/or one-year irnprlsonrx�ent,as w p day against the violator.A copy of flus statement may be forwarded to#lro Office of luvestigstions of ilia DTA for surance coverage verifiration. Ido hereby certify oder't e a' andp aloes of peijuay that floe information provided alcove is true acid cort'ect Date: Si azure: Phone 4: Official use only. Do notwrite in this area,to he completed by city or torten off clot` permit/License# City or TOUR: issuing Anthorxty(Circle ane): s tar 1.Board o f Health ?,.Building Department 3.CitylTown Clerk 4.L+lectrical Inspector 5.Plumbing I"nspec 6.Cilrer Phone#. Contact-Person i